
I think I'd be safe in saying that you've never heard of this book, but if you watch TV, you know about the Will Smith movie of the same name due to open on Christmas. This is the source material for the movie and it is a true story.
Bennet Omalu is a Nigerian physician who never really wanted to follow in the family footsteps. He had no interested in village politics or farming or sports or schmoozing with the local residents. He wanted more and managed to work out a move to the US to continue his medical studies.
After a few years as a medical vagabond, taking graduate degrees from various universities, he began to realize that his destiny wasn't in treating patients. He preferred to study the dead, thus his desire to practice forensic pathology and he would become Board Certified in a number of pathology subspecialties including neuropathology-his favorite. So he applied for and was accepted into the pathology fellowship at the University of Pittsburgh Medical Center. The Alleghany County Medical Examiner was the very high profile Cyril Wecht who, apart from his County duties was also the coroner for some high-profile cases across the country (e.g., Jon Benet Ramsey, OJ, Vincent Foster, and dozens of others). Wecht is a profane, bombastic, self-promoter and the perfect mentor for the withdrawn Omalu.
Omalu was one of a number of junior pathologists in the rotation. In 2002, Omalu was next up to do the autopsy on what he assumed was a homeless man. One of the techs said, 'so you got the winning ticket.'
The patient was Mike Webster. To Omalu, Webster was a nobody, a street person. To Steeler Nation though, Mike Webster was a God (
and if you are a football fan and don't know who Mike Webster was . . . well, you better do some research on the Pittsburgh Steelers of the 1970s and 1980s).
While Omalu did a routine autopsy on Webster, the paperwork described significant behavioral issues in his later years, which he thought were curious given that Webster was only 50 years old and an ex-professional athlete (
the litany of Webster's issues will really open your eyes). He asked Dr. Wecht if it would be OK if he kept Webster's brain for further study.
The brain was preserved and Omalu kept it in his condo because any further study would have to be off the books; the Webster case was officially closed (
the eventual legal case would soon be heating up). After a few weeks, he took samples of the brain to histology for a battery of stains to look at a wide range of neuropathology issues.
What he found startled him. Webster's brain looked grossly normal, but there were tissue sections that appeared to come from someone decades older with advanced dementia or Alzheimer's disease. As Omalu dug a bit deeper into Webster's medical history and his post-NFL life, Omalu began to believe that Webster's brain and behavior were the results of a lifetime of head trauma.
He published his case study in the journal
Neurosurgery (
that links to the paper's abstract) because it had a history of publishing papers on traumatic brain injury. And that's when Omalu's life went into a professional tailspin. The Mild Traumatic Brain Injury Committee of the NFL wrote the journal and wanted the article retracted and to never consider any future submissions of his. Omalu's life would never be the same.
[For those not familiar with medicine, when an unusual patient is encountered, it is routine to write up a 'case study,' which is little more than a brief article that describes what was unique about the patient, what was done, the outcome, and some comments. Medicine is all about 'evidence' and medical evidence is ranked from Level 1 (the highest and most convincing) to Level 5 (the lowest class that is dominated by case studies). Webster's case was unique so Omalu had to come up with a diagnosis; an easily remembered term and initialism for future use. He called it CTE: Chronic Traumatic Encephalopathy. He had come up with a medical term that had previously been termed the 'punch drunk syndrome' in boxers. The book says that the NFLs retraction request was longer than Omalu's published case report.]
This book is an extension of an article Laskas wrote for GQ in 2009 called 'Game Brain.' In the book, she goes into some detail of Omalu's childhood in Nigeria, his relationship with his father and family, Omalu's medical journey in the US, his developing relationship with Prema, a nursing student (and later, his wife), and the death of his father. All that is fine as it gives us some context to the man Omalu becomes.
But the story begins in earnest with Mike Webster's death. Once he published that case study, the full weight of the NFL comes down on Omalu in the time-honored tradition of character assassination and belittling someone from outside the game who had the audacity to challenge an entity that, for all intents and purposes, owns a day of the week. That Omalu is also Nigerian and not a part of the NFL machine makes this a David vs. Goliath on the first order. Some say there was/is a racial component, which seems odd considering that the NFL is something like 65% black. But that's the players. Ownership, league management (and physicians) are overwhelmingly white. Laskas shows us once again how the NFL can't seem to get out of its own way when it comes to crises management (
the recent domestic violence issues come to mind). In multiple instances, Laskas shows how the NFL's stance on concussions parallels Big Tobacco's stance on smoking, addiction, and life-limiting diseases like cancer and heart disease.
Some disclosure here. I have read Omalu's papers (and he didn't challenge the NFL. He just said that CTE needed to be studied further, a common conclusion in dang near every medical paper written-I'm a medical editor so I should know). I've also read the series of papers by the NFL's MTBI committee that make a mockery of concussion as an academic endeavor worthy of study. And I personally know some of the people mentioned in the book. My game is soccer and I've had 2 concussions that I can recall. I have also published a few papers on concussion so I have more than a passing interest in this book and the coming movie.
Despite the NFLs (and FIFAs, but at least FIFA never said that head injury wasn't a problem like the NFL did) stance that they are devoted to player safety, no organization has done it 'right' yet because no one really knows what's going on inside the head during sport (within the past month US Soccer told the American soccer community that no child 10y or younger is to be taught how to head a ball. Some think the age should be 14y).
Concussions are
THE hot topic in sports medicine and that means lots of people are studying it in order to find a way to make
(insert your favorite sport here) safer. We see news reports of players who have willed their brain to the project underway at Boston University (another political issue discussed in the book: what wasn't/isn't Omalu involved? He discovered CTE, for crying out loud). Currently, there have been something like 79 brains donated and 77 show evidence of CTE. What they really need are some 'control' brains (players with no documented concussions. This is particularly important in soccer to determine if purposeful, successful heading can be implicated in CTE). That's when this issue will really heat up. A few years ago, I was asked about CTE and football. My response included a comment that CTE had the potential to destroy the game of football. Probably not in our lifetime, but sometime in the future. If parents continue to steer their sons away from football, the player pool will eventually dry up. Stay tuned. This issue is far from resolved, no matter what the governing body of any sport says.
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